KidsCAN Bake Registration Form
Five week After School program Wednesdays, April 8 - May 6th
Name of child
*
Birth Date
Address:
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Name of Parent/Guardian
E-mail
example@example.com
Home Number
Cell Number
Alternate Contact/ authorized to pick up child:
Do you consent for your child to be in photos?
Yes I consent
No I do not consent
Back
Next
*
prev
next
( X )
Registration Fee
1 Child all sessions
$
60.00
CAD
Credit Card
Submit Form
Should be Empty: